Switch to natalizumab versus fingolimod in active relapsing-remitting multiple sclerosis

Kalincik, Tomas, Horakova, Dana, Spelman, Tim, Jokubaitis, Vilija, Trojano, Maria, Lugaresi, Alessandra, Izquierdo, Guillermo, Rozsa, Csilla, Grammond, Pierre, Alroughani, Raed, Duquette, Pierre, Girard, Marc, Pucci, Eugenio, Lechner-Scott, Jeannette, Slee, Mark, Fernandez-Bolanos, Ricardo, Grand'Maison, Francois, Hupperts, Raymond, Verheul, Freek, Hodgkinson, Suzanne, Oreja-Guevara, Celia, Spitaleri, Daniele, Barnett, Michael, Terzi, Murat, Bergamaschi, Roberto, McCombe, Pamela, Sanchez-Menoyo, Jose, Simo Magdolna, Csepany, Tunde, Rum, Gabor, Boz, Cavit, Havrdova, Eva, Butzkueven, Helmut and and on behalf of the MSBase Study Group (2015) Switch to natalizumab versus fingolimod in active relapsing-remitting multiple sclerosis. Annals of Neurology, 77 3: 425-435. doi:10.1002/ana.24339

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Author Kalincik, Tomas
Horakova, Dana
Spelman, Tim
Jokubaitis, Vilija
Trojano, Maria
Lugaresi, Alessandra
Izquierdo, Guillermo
Rozsa, Csilla
Grammond, Pierre
Alroughani, Raed
Duquette, Pierre
Girard, Marc
Pucci, Eugenio
Lechner-Scott, Jeannette
Slee, Mark
Fernandez-Bolanos, Ricardo
Grand'Maison, Francois
Hupperts, Raymond
Verheul, Freek
Hodgkinson, Suzanne
Oreja-Guevara, Celia
Spitaleri, Daniele
Barnett, Michael
Terzi, Murat
Bergamaschi, Roberto
McCombe, Pamela
Sanchez-Menoyo, Jose
Simo Magdolna
Csepany, Tunde
Rum, Gabor
Boz, Cavit
Havrdova, Eva
Butzkueven, Helmut
and on behalf of the MSBase Study Group
Title Switch to natalizumab versus fingolimod in active relapsing-remitting multiple sclerosis
Journal name Annals of Neurology   Check publisher's open access policy
ISSN 1531-8249
0364-5134
Publication date 2015-03-01
Sub-type Article (original research)
DOI 10.1002/ana.24339
Volume 77
Issue 3
Start page 425
End page 435
Total pages 11
Place of publication Hoboken, NJ, United States
Publisher John Wiley and Sons
Collection year 2016
Language eng
Subject 2808 Neurology
2728 Clinical Neurology
2700 Medicine
Formatted abstract
Objective
In patients suffering multiple sclerosis activity despite treatment with interferon β or glatiramer acetate, clinicians often switch therapy to either natalizumab or fingolimod. However, no studies have directly compared the outcomes of switching to either of these agents.

Methods
Using MSBase, a large international, observational, prospectively acquired cohort study, we identified patients with relapsing–remitting multiple sclerosis experiencing relapses or disability progression within the 6 months immediately preceding switch to either natalizumab or fingolimod. Quasi-randomization with propensity score–based matching was used to select subpopulations with comparable baseline characteristics. Relapse and disability outcomes were compared in paired, pairwise-censored analyses.

Results
Of the 792 included patients, 578 patients were matched (natalizumab, n = 407; fingolimod, n = 171). Mean on-study follow-up was 12 months. The annualized relapse rates decreased from 1.5 to 0.2 on natalizumab and from 1.3 to 0.4 on fingolimod, with 50% relative postswitch difference in relapse hazard (p = 0.002). A 2.8 times higher rate of sustained disability regression was observed after the switch to natalizumab in comparison to fingolimod (p < 0.001). No difference in the rate of sustained disability progression events was observed between the groups. The change in overall disability burden (quantified as area under the disability–time curve) differed between natalizumab and fingolimod (−0.12 vs 0.04 per year, respectively, p < 0.001).

Interpretation
This study suggests that in active multiple sclerosis during treatment with injectable disease-modifying therapies, switching to natalizumab is more effective than switching to fingolimod in reducing relapse rate and short-term disability burden.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2016 Collection
School of Medicine Publications
 
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Created: Tue, 01 Mar 2016, 11:09:43 EST by Matthew Lamb on behalf of School of Medicine